A 66-year-old male patient with malignant melanoma received combined treatments with apatinib (oral 250 mg once daily), temozolomide (oral 500 mg on day 1 and 400 mg/d on days 2-4), toripalimab(240 mg intravenous infusion on days 1 and 15). After 5 cycles (28 days as a cycle), the patient developed multiple rashes, which were not alleviated after reducing the dose of apatinib to 250 mg orally once every 3 days in the 6th treatment cycle. Laboratory tests showed that serum albumin was 28.5 g/L, total serum protein was 55.5 g/L, eosinophil percentage was 0.096, and venous potassium was 3.17 mmol/L. Erythroderma caused by combination of apatinib and toripalimab was considered, and the 2 drugs were stopped. The patient received the treatments of methylprednisolone, loratadine, diphenhydramine, triamcinolone acetonide and econazole nitrate cream and mupirocin ointment (external coating), and skin care. At the same time, symptomatic treatments such as protein supplement, diuresis, potassium supplement, and stomach protection were given. After 10 days of treatments, the rash subsided, and desquamation and itching were improved.

A 49-year-old male patient with primary hepatocellular carcinoma was treated with donafenib combined with tislelizumab. After 2 cycles of treatments, he developed persistent fever, poor appetite, fatigue, decreased white blood cells, hemoglobin, platelets, and fibrinogen, and significant increase of serum ferritin(91 501 μg/L) and splenomegaly. Hemophagocytic lymphohistiocytosis was diagnosed, which was consideredto be caused by tislelizumab. He received intravenous infusion of methylprednisolone 60 mg/d for 4 days, 40 mg/d for 7 days, 28 mg/d for 5 days, and at last, oral prednisone 35 mg/d was given, with dose reduction to discontinuation within 4-6 weeks. During the treatment, his laboratory tests results were improved. The patient did not use tislelizumab again and donafenib treatment was reused, and the above symptoms did not recur.

A 66-year-old male patient with malignant melanoma received combined treatments with apatinib (oral 250 mg once daily), temozolomide (oral 500 mg on day 1 and 400 mg/d on days 2-4), toripalimab(240 mg intravenous infusion on days 1 and 15). After 5 cycles (28 days as a cycle), the patient developed multiple rashes, which were not alleviated after reducing the dose of apatinib to 250 mg orally once every 3 days in the 6th treatment cycle. Laboratory tests showed that serum albumin was 28.5 g/L, total serum protein was 55.5 g/L, eosinophil percentage was 0.096, and venous potassium was 3.17 mmol/L. Erythroderma caused by combination of apatinib and toripalimab was considered, and the 2 drugs were stopped. The patient received the treatments of methylprednisolone, loratadine, diphenhydramine, triamcinolone acetonide and econazole nitrate cream and mupirocin ointment (external coating), and skin care. At the same time, symptomatic treatments such as protein supplement, diuresis, potassium supplement, and stomach protection were given. After 10 days of treatments, the rash subsided, and desquamation and itching were improved.

A 49-year-old male patient with primary hepatocellular carcinoma was treated with donafenib combined with tislelizumab. After 2 cycles of treatments, he developed persistent fever, poor appetite, fatigue, decreased white blood cells, hemoglobin, platelets, and fibrinogen, and significant increase of serum ferritin(91 501 μg/L) and splenomegaly. Hemophagocytic lymphohistiocytosis was diagnosed, which was consideredto be caused by tislelizumab. He received intravenous infusion of methylprednisolone 60 mg/d for 4 days, 40 mg/d for 7 days, 28 mg/d for 5 days, and at last, oral prednisone 35 mg/d was given, with dose reduction to discontinuation within 4-6 weeks. During the treatment, his laboratory tests results were improved. The patient did not use tislelizumab again and donafenib treatment was reused, and the above symptoms did not recur.

Objective:To explore the curative effect of synchronous bionic electrical stimulation in hyperbaric oxygen chamber on patients with sudden deafness（SD）and the changes in hemorheological indicators.Methods:A total of 128 SD outpatients and inpatients treated at the Hyperbaric Oxygen Department of the Sixth Medical Center of the Chinese PLA General Hospital from June 2020 to June 2021 were randomly divided into study group（70 cases treated with synchronous brain bionic electrical stimulator in hyperbaric oxygen chamber）and control group（58 cases given conventional hyperbaric oxygen therapy），respectively. The curative effects of the two groups were evaluated，and the hemorheological indicators，such as the whole blood（high-shear and low-shear）viscosity，plasma viscosity，and red blood cell aggregation，were analyzed by the automatic biochemical analyzer before and after treatment.Results:After two courses of treatments，the overall effective rate of the study group（88.57%）was significantly higher than that of the control group（79.31%），and the difference was statistically significant（ P<0.05）. After treatment，the whole blood（high-shear and low-shear）viscosities，plasma viscosity，and erythrocyte aggregation indicators of the two groups were significantly decreased compared with those before treatment（ P<0.05），and the above indicators in the study group were significantly lower than those in the control group（ P<0.05）. Conclusions:Synchronous brain bionic electrical stimulation in the hyperbaric oxygen chamber can improve the hemorheological indicators of the SD patients，reduce their blood hypercoagulability，and improve their hearing level and treatment effect. Hence，it is worth of clinical promotion.

Objective:To explore the curative effect of synchronous bionic electrical stimulation in hyperbaric oxygen chamber on patients with sudden deafness（SD）and the changes in hemorheological indicators.Methods:A total of 128 SD outpatients and inpatients treated at the Hyperbaric Oxygen Department of the Sixth Medical Center of the Chinese PLA General Hospital from June 2020 to June 2021 were randomly divided into study group（70 cases treated with synchronous brain bionic electrical stimulator in hyperbaric oxygen chamber）and control group（58 cases given conventional hyperbaric oxygen therapy），respectively. The curative effects of the two groups were evaluated，and the hemorheological indicators，such as the whole blood（high-shear and low-shear）viscosity，plasma viscosity，and red blood cell aggregation，were analyzed by the automatic biochemical analyzer before and after treatment.Results:After two courses of treatments，the overall effective rate of the study group（88.57%）was significantly higher than that of the control group（79.31%），and the difference was statistically significant（ P<0.05）. After treatment，the whole blood（high-shear and low-shear）viscosities，plasma viscosity，and erythrocyte aggregation indicators of the two groups were significantly decreased compared with those before treatment（ P<0.05），and the above indicators in the study group were significantly lower than those in the control group（ P<0.05）. Conclusions:Synchronous brain bionic electrical stimulation in the hyperbaric oxygen chamber can improve the hemorheological indicators of the SD patients，reduce their blood hypercoagulability，and improve their hearing level and treatment effect. Hence，it is worth of clinical promotion.

Objective:To understand and explore the psychological experience of standardized patients, in order to provide an effective basis for training and applying standardized patients.Methods:The phenomenological methodology in qualitative research was used in the study, and the Colaizzi 7-step data analysis method was used for analysis the interview recording.Results:The psychological experience of standardized patients can be summarized into three themes: understanding of pressure from medical staffs, the desire for balance the effort and harvest, challenge and growth.Conclusions:Medical staffs need to considere the psychological experience of standardized patients in the training and application, pay more attention to their psychological changes and provide corresponding work and emotional support.

OBJECTIVE： To study the anti-tumor effect of anemoside B4 （AB4） on hepatocellular carcinoma Huh-7 and tumor-bearing nude mice and its mechanism. METHODS： Huh-7 cells were divided into AB4 treatment group， negative control group （constant volume of culture medium） and positive control group （5-fluorouracil 50 μmol/L）. The inhibitory rate of Huh-7 cell proliferation was tested by MTT after treated with 0， 3， 6， 12， 25， 50， 100， 200， 400， 800， 1 600 μmol/L AB4 for 12， 24， 36， 48 h； IC50 were calculated. The number of clone cells was evaluated by clone formation tests after Huh-7 cells were treated with 50 μmol/L AB4 for 24 h. The apoptosis rate of Huh-7 cells was tested by Annexin Ⅴ-FITC/PI double staining after treated with 50 μmol/L AB4 for 24 h. The expression of apoptotic proteins such as Bcl-2， Bax， Caspase-3， Cleaved Caspase-3 and Cleaved PARP were tested by Western blot after Huh-7 cells were treated with 50 μmol/L AB4 for 24 h. Tumor-bearing nude mice were randomly divided into negative control group （normal saline）， positive control group （5-fluorouracil 50 mg/kg）， AB4 lwo-dose， medium-dose and high-dose groups （25， 50， 100 mg/kg）， with 3 mice in each group. They were given relevant medicine intraperitoneally， once a day， for consecutive 19 d. The growth of tumor was observed， and anti-tumor rate was also calculated. HE staining was used to observe the morphology of tumor cells. RESULTS： The inhibition rate of AB4 on Huh-7 cell proliferation increased with the increase of concentration of AB4， but it did not increase significantly after reaching 50 μmol/L； it increased with the increase of time， but it did not increase significantly after 24 h. The IC50 of AB4 was （56.76±1.756） μmol/L. Compared with negative control group， the number of clone cells was decreased significantly after Huh-7 cells were treated with 50 μmol/L AB4 for 24 h， while the protein expression of Bcl-2 was decreased significantly （P＜0.05）； the apoptotic rate， the protein expression of Bax， Caspase-3， Cleaved Caspase-3 and Cleaved PARP were increased significantly （P＜0.05 or P＜0.01）， there was no statistical significance， compared with positive control group. Compared with negative control group， the volume of tumor was decreased significantly in AB4 low-dose， medium-dose and high-dose groups， positive control group （P＜0.05）； the outline of tumor cells become more and more blurred； there were nuclear pyknosis， unclear nucleoplasm and nuclear fragmentation； its anti-tumor rates were 25.93％， 39.15％， 46.26％， 42.83％， respectively. CONCLUSIONS： AB4 inhibits Huh-7 cells and tumor-bearing mice， the mechanism of which may be associated with up-regulating the proportion of Bax/Bcl-2， activating Caspase-3， cracking PARP and inducing apoptosis.

Objective To explore the association between expression changes of plasma macrophages scavenger receptor (SR)-B Ⅰ and CD36 and risk of arteriosclerosis in end-stage liver disease (ESLD) patients post liver transplantation.Methods A total of 20 liver transplantation patients were included.Clinical data including blood pressure,blood lipid,blood glucose,incidence of new-onset cardiovascular events were obtained.Plasma macrophages scavenger receptor SR-B Ⅰ and CD36 expressions were detected by polymerase chain reaction (RT-PCR) and Western-blot before and at 1 year after liver transplantation.Results The serum levels of TC [(5.34 ± 0.87) mmol/L vs.(4.27 ± 0.91) mmol/L],TG [(2.47±0.81)mmol/Lvs.(1.02±0.49)mmol/L] and LDL-C [(3.36±0.67)mmol/Lvs.(2.14± 0.74) mmol/L] were significantly increased (P ＜ 0.05) while the serum level of HDL-C [(0.98 ± 0.84) mmol/L vs.(1.58 ± 0.34) mmol/L] was significantly reduced (P ＜ 0.05) at 1 year post transplantation compared to before-transplantation levels.One patient developed non-ST segment elevation myocardial infarction and treated with percutaneous coronary intervention,another patient developed atrial fibrillation at one year after transplantation.The plasma mRNA expression of SR-B [was reduced (20.44 ± 0.60 vs.23.12 ±0.69,P ＜0.05) while the expression of CD36 mRNA was upregulated(20.91 ±0.35 vs.18.55 ± 0.62,P ＜ 0.05) at 1 year after liver transplantation compare with that of before the transplantation.Similarly,the plasma protein expression of SR-B Ⅰ was reduced (0.21 ± 0.13 vs.0.64 ± 0.28,P ＜ 0.05) while the protein expression of CD36 was upregulated (0.94 ± 0.13 vs.0.42 ± 0.19,P ＜ 0.05) at 1 year after liver transplantation compare with that of before the transplantation.Conclusion Plasma expression changes of SR-B Ⅰ and CD36 might contribute to the dyslipidemia and contribute to the atherosclerosis susceptibility after liver transplantation.